HomeMy WebLinkAboutPermit Plumbing 1988-2-10
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j'INSPECTION LINE
726c3769
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I Job Address
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CITY UF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
l~ater Hea ter
Range
ValuE of Hor":
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Builoina Permit Info: Describe Work.{;~e.. Build Single
Familv Residence With Attached Garaoe)
/8~TA'~~ ~Rk.....N~ ~r"?,"
7)q~/#AT;:;,5' ~ P.x>e;.c_
~/.ri~n'-? &e~.h'~s-',
(lies. no.) (exo;resl
INFDRlIATlON LINL
726-37S3
Sq. Ftq, ',lain
:q. Ftg. Access.
Sq, Ftq, Other
New Add Alter Pep,
-Fence Demo Change/Use
Other- -
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IV)
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Legal Descript;on /,t:S--Q?-/?c:.-I? 04lq'Q1
Owner .'::;PRilV~F/€LD nEUe::: .~~~<;
Address .?2 S /;i?/J!.L -5' r Phone
5~/;Y":;;.I9~I'O~,
Construction lender
Address
ULS j tiN ITAI1
(namel
Phone
(address)
(ohane no.
Primary ~ ?./'57'..
Structural
Electrical
Mechanical
CONTRACTORS
Genera 1
Plumbino
Electrical
~'echanical
NO,
(name)
(address)
(exnires'
(I)honp~'-
(lies. no.)
PLUI,IB I NG
ELECTRICAL
MECHANICAL
FEE r.H^Rr,~ Nn~ ~ ~~~ r~~ NO
Residence of furnace/burner to
SQ, FT, BTU's
j:'j:'j:' rl-lAR!iE.
Each Single fixture
Relocated building
(new fix, additional)
l's.F. Residence
(] bath 1
IDuplex (1 bath) each
IAdditional bath
I ~Ia ter servi ce
I Sewer
?~IStorm Sewer
1
I
I
1
1
1
INew circuits alts.
or extensions
Floor furnace
and vent
I SERVICES
I
Recessed wall
So~cP hp~tpr ~nn vpnt
~,.
ITemporary Construction
IChange in existing
rpc:, j qp.J1cp
Imultifamily, comm. or
Ind\Jc:,tri~l
IOf amps,l
ICO~1,/IND, FEEDERS
IInstall/alter/relocate I
rli'=.trih fj:>prlprc::
IOf amp~1
Wood stove/heater
Appliance vent
seoari't.to
Stationarv evao.
cooler" .
Vent fa'n with
sinol!:! duct
Vent system apart from
hf'atinq or A.C.
Mechanical exhaust
hood and duct
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
ISSUANCE OF PFR!IIT
s-a ~ TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an"Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that ue OCCUPAfKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ens 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with ORS 7nl.055 will be used on this project.
). ,-flp'p'/~D I-Z;?-88
IWIE(please print) / ?y-;1)J" .4 UOcl <; SIGtlATURE @ '7 ~ -?- DATE.2-I'O-~
, - - ...;:. FOr. OFFICE USE miL Y ,
Type/Const~V'/~ Units Sq. Ftg. riain x Value
Bedrooms Occy Load Sq, Ft9, Acce~,...Ifi'-:;;' ~~/.d~alue :7~_ ~oo
Stories Occy Group Sq, Ftg, Otheru.""~~~.l.Sovalue ,,/ ::z<Z~
TOTAL VALUATIOtIZ,"f, .-.::; ~ ~
Zone p~O
Fi re Zone
Flood Plain
BUILDING PER~1lT
Charges and
Surcharges
PLU!1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERIIlT
Cha rges and
Surcharges
MECHANICAL PERMIT
~~:~~ and
..es
Plan Ck, Comm/lnd
____________~/Bldn Pj:>r Fpto
Plan Ck, Res
30%/Bldo Per Fee
_____S.J):~6 Fence
2:,$"0 Demo
_ _____ ___ __J 'Sidewalk
[ A/C Paving
Curb Cut
. ~__ _ Systems Development
/HK~4':'-At:;Q Charqe (l.S%j
/7,0, :5""0 Total Comb, Permit
I
-[TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
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_PERMIT'VALIDATION
I I I.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot
11 03 43
2, example- Lot I, Block 3, 2nd Addition to
. ." Spnngtield_Estates '. ".~ .. ..... - '.'
C. Name, etc. of owner and construction lender
D. Energy Sources ..' . .
"I. "exaomple- he'at/elec'trical ceifing/or' fo~ced air qas
2. .examole- waterheater/electncaN-or solar.
E. Square footage or valuation, etc. -----
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check. add, etc.
f. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
II, Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
0, As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is .not authorized
to sign the electrical label, ---
Applicant to sign and date
Whenever possible, the initial application will be. used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV, Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
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100, Lane County Map Reference
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V, FOR OFFICE USE ONLY
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
''''~': '.
Permit applicant exempt from registration with the Builder's'Board because:
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Addi t.i ona 1 Project Infonnati on:
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PLANS REVIEWED BY:
'f~~~e: '/,'~-~ 7?:-~6Z? '~ig~ature ~~/?"._
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date :2.-5"-88
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